4. Names, addresses (street & P.O.), telephone numbers of other offices/chapters/branches/affiliates (attach list). 5. Date incorporated _______________________________ State of incorporation ______________________________
Fiscal year end: day/month _______________________________________
6. If not incorporated, type of organization, state, and date established __________________________________________
________________________________________________________________________________________________ 7. Has organization or any of its officers, directors, employees or fund raisers: A. Been enjoined or otherwise prohibited by a government agency/court from soliciting? Yes No
B. Had its registration denied or revoked? Yes No
C. Been the subject of a proceeding regarding any solicitation or registration? Yes No
D. Entered into a voluntary agreement of compliance with any government agency or in a case before a court or administrative agency? Yes No
E. Applied for registration or exemption from registration (but not yet completed or obtained)? Yes No
F. Registered with or obtained exemption from any state or agency? Yes No
G. Solicited funds in any state? Yes No
If “yes” to 7A, B, C, D, E, attach explanation.
If “yes” to 7F & G, attach list of states where registered, exempted, or where it solicited, including registering agency, dates of registration, registration numbers, any other names under which the organization was/is registered, and the dates and type (mail, telephone, door to door, special events, etc.) of the solicitation conducted.
8. Has the organization applied for or been granted IRS tax exempt status? Yes No
If yes, date of application OR date of determination letter . If granted, exempt under 501(c) . Are contributions to the organization tax deductible? Yes No
NAAG/NASCO Standardized Reporting URS v. 4.01 Pg2
9. Has tax exempt status ever been denied, revoked, or modified? Yes No 10. Indicate all methods of solicitations:
Mail Telephone Personal Contact Radio/TV Appeals Special Events Newspaper/Magazine Ads Other(s) (specify) 11. List the NTEE code(s) that best describes your organization , , 12. Describe the purposes and programs of the organization and those for which funds are solicited (attach separate sheet if
13. List the names, titles, addresses, (street & P.O.), and telephone numbers of officers, directors, trustees, and the principal
salaried executives of organization (attach separate sheet). 14. (A) (1) Are any of the organization’s officers, directors, trustees or employees related by blood, marriage, or adoption to:
(i) any other officer, director, trustee or employee OR (ii) any officer, agent, or employee of any fundraising professional firm under contract to the organization OR (iii) any officer, agent, or employee of a supplier or vendor firm providing goods or services to the organization? Yes No
(2) Does the organization or any of its officers, directors, employees, or anyone holding a financial interest in the organization have a financial interest in a business described in (ii) or (iii) above OR serve as an officer, director, partner or employee of a business described in (ii) or (iii) above? Yes No (If yes to any part of 14A, attach sheet which specifies the relationship and provides the names, businesses, and addresses of the related parties).
(B) Have any of the organization’s officers, directors, or principal executives been convicted of a misdemeanor or felony? (If yes, attach a complete explanation.) Yes No
15. Attach separate sheet listing names and addresses (street & P.O.) for all below:
Individual(s) responsible for custody of funds. Individual(s) responsible for distribution of funds.
Individual(s) responsible for fund raising. Individual(s) responsible for custody of financial records.
Individual(s) authorized to sign checks. Bank(s) in which registrant’s funds are deposited (include account number and bank phone number). 16. Name, address (street & P.O.), and telephone number of accountant/auditor.
Name __________________________________________________________________________________________
City State Zip Code Telephone ______________________
Method of accounting _____________________________________________________________________________ 17. Name, address (street & P.O.), and telephone number of person authorized to receive service of process. This is a state-
specific item. See instructions. Name __________________________________________________________________________________________
City State Zip Code Telephone ______________________
NAAG/NASCO Standardized Reporting URS v. 4.01 Pg3
18. (A) Does the organization receive financial support from other nonprofit organizations (foundations, public charities, combined campaigns, etc.)? Yes No
(B) Does the organization share revenue or governance with any other non-profit organization? Yes No
(C) Does any other person or organization own a 10% or greater interest in your organization OR does your organization own a 10% or greater interest in any other organization? Yes No
(If “yes” to A, B or C, attach an explanation including name of person or organization, address, relationship to your organization, and type of organization.)
19. Does the organization use volunteers to solicit directly? Yes No
Does the organization use professionals to solicit directly? Yes No
20. If your organization contracts with or otherwise engages the services of any outside fundraising professional (such as a “professional fundraiser,” “paid solicitor,” “fund raising counsel,” or “commercial co-venturer”), attach list including their names, addresses (street & P.O.), telephone numbers, and location of offices used by them to perform work on behalf of your organization. Each entry must include a simple statement of services provided, description of compensation arrangement, dates of contract, date of campaign/event, whether the professional solicits on your behalf, and whether the professional at any time has custody or control of donations.
21. Amount paid to PFR/PS/FRC during previous year: $
22. (A) Total contributions: $
(B) Program service expenses: $
(C) Management & general expenses: $
(D) Fundraising expenses: $
(E) Total expenses: $
Under penalty of perjury, we certify that the above information and the information contained in any attachments or supplement is true, correct, and complete. Sworn to before me on (or signed on) , 20 Notary public (if required) _________________________________________ Name (printed) Name (printed) ________________________________________ Name (signature) Name (signature) ________________________________________ Title (printed) Title (printed)
(F) Fundraising expenses as a percentage of funds raised: ______________%
(G) Fundraising expenses plus management and general expenses as a percentage of funds raised: _________%
(H) Program services as a percentage of total expenses: ___________%
National Coalition for the Homeless 2201 P Street, NW Tel. 202-462-4822 Washington, DC 20037-1033 Fax. 202-462-4823 http://www.nationalhomeless.org Email. [email protected]
Bringing America Home
LIST OF STATES WHERE REGISTERED TO SOLICIT
State Registering Agency Registration Renewal Date
Registration Number
Solicitation Type
Solicitation Dates
Arizona Secretary of State November 15, 2011
24305 Mail, Email Ongoing
California Office of Attorney General
November 15, 2011
111899 Mail, Email Ongoing
Colorado Secretary of State November 15, 2011
20033002911 Mail, Email Ongoing
Delaware Not required Not required Not required Not required Not requiredDistrict of Columbia
Dept. of consumer and regulatory affairs
January 1, 2012 68001286 Mail, Email Ongoing
Florida Dept. of Agriculture and Consumer Services
November 15, 2011
CH2970 Mail, Email Ongoing
Georgia Secretary of State July 8, 2011 4188 Mail, Email Ongoing Idaho Not required Not required Not required Not required Not requiredIllinois Illinois Charity
Bureau Fund November 15, 2011
01025338 Mail, Email Ongoing
Indiana Not required Not required Not required Not required Not requiredIowa Not required Not required Not required Not required Not requiredKansas Secretary of State December 31,
2011 Mail, Email Ongoing
Kentucky Office of Attorney General
December 31, 2011
- Mail, Email Ongoing
Louisiana Consumer Protection Section
Not required Not required Not required Not required
Maryland Secretary of State December 31, 2011
4969 Mail, Email Ongoing
Massachusetts Commonwealth of Massachusetts
November 15, 2011
030516 Mail, Email Ongoing
Minnesota State of Minnesota January 15, 2012
52-1517415 Mail, Email Ongoing
Montana Not required Not required Not required Not required Not requiredNebraska Not required Not required Not required Not required Not requiredNevada Not required Not required Not required Not required Not requiredNew Jersey NJ Division of
Consumer Affairs December 31, 2011
CH0588100 Mail, Email Ongoing
New York NYS Dept of Law November 30, 2011
03-57-62 Mail, Email Ongoing
North Carolina
North Carolina Secretary of State
November 15, 2011
SL000110 Mail, Email Ongoing
Bringing America Home
Ohio Treasurer of the State of Ohio
November 15, 2011
14-0120 Mail, Email Ongoing
Pennsylvania Commonwealth of Pennsylvania
May 11, 2012 11701 Mail, Email Ongoing
South Carolina
Secretary of State November 15, 2011
C4228 Mail, Email Ongoing
South Dakota Not required Not required Not required Not required Not requiredTexas Not required Not required Not required Not required Not requiredVermont Not required Not required Not required Not required Not requiredVirginia Treasurer of
Virginia November 15, 2011
Mail, Email Ongoing
Wisconsin Dept. of Regulation & Licensing
July 31, 2012 3908-800 Mail, Email Ongoing
Wyoming Not required Not required Not required Not required Not required
National Coalition for the Homeless 2201 P Street, NW Tel. 202-462-4822 Washington, DC 20037-1033 Fax. 202-462-4823 http://www.nationalhomeless.org Email. [email protected] PURPOSE AND PROGRAMS The National Coalition for the Homeless is the positive result of a committed group of social activists who in 1981 won landmark litigation to protect the rights of homeless people to shelter and voting. Today, NCH continues its strong social justice work by providing a national platform for “first person” homeless voices. NCH’s mission is to end homelessness and believes that the un-housed must be recognized for their natural worth and respected for their innate dignity. To that end, NCH works towards creating the systemic change through its grassroots organizing and public education around issues of housing, healthcare, economic justice and civil rights.
Bringing America Home
National Coalition for the Homeless 2201 P Street, NW Tel. 202-462-4822 Washington, DC 20037-1033 Fax. 202-462-4823 http://www.nationalhomeless.org Email. [email protected] BOARD OF DIRECTORS AND KEY EMPLOYEES EC = Executive Committee NEIL DONOVAN EXECUTIVE DIRECTOR MICHAEL STOOPS DIRECTOR OF COMMUNITY ORGANIZING MEGAN HUSTINGS DEVELOPMENT DIRECTOR JOHN PARVENSKY, EC, BOARD PRESIDENT President Colorado Coalition for the Homeless 2111 Champa St. Denver, CO 80205 WO: 303/293-2217 x1104 FAX: 303/293-2309 Email [email protected] BRIAN DAVIS, VICE PRESIDENT Northeast Ohio Coalition for the Homeless 3631 Perkins Ave 3A-3 Cleveland, OH 44114 WO: 216/432-0540 FAX: 216/432-0620 Email: [email protected] SUE WATLOV PHILLIPS, EC, TREASURER Elim Transitional Housing, Inc. 3989 Central Ave. NE, Ste. 565 Minneapolis, MN 55421-3972 WO: 763/788-1546 x3 FAX: 763/788-1672 Email [email protected] SHERRI DOWNING, EC, SECRETARY Montana Council on Homelessness 3362 Tizar Dr. Helena, MT 59602 WO: 406/443-0580 FAX: 406/443-0869 Email: [email protected]
BARBARA ANDERSON, EC President Indiana Coalition for the Homeless P.O. Box 1544 c/o Haven House Services Jeffersonville, IN 47130 WO: 812/284-3373 x105 FAX: 812/284-1665 Email: [email protected] ANITA BEATY, EC Executive Director Metro Atlanta Task Force for the Homeless 477 Peachtree St. Atlanta, GA 30308 WO: 404/230-5007 x118 FAX: 404/589-8251 Email [email protected] MICHAEL D. CHESSER, EC Executive Director Upstate Homeless Coalition of South Carolina 150 Executive Dr; Box 211 Greenville, SC 29615 WO: 864/770-0704 Fax: 864/241-0464 Email: [email protected] BOB ERLENBUSCH, EC Sacramento Hunger Coalition Community Services Planning Council 909 12th Street, Suite 200 Sacramento, CA 95814 WO: 916/447-7063, ext 335 Email: [email protected] PHILLIP PAPPAS, EC 257 Maple Ave. Pittsburgh, PA 15218 FAX: 412/731-3427 Email [email protected]
Bringing America Home
RICHARD TROXELL, EC President House the Homeless, Inc. 4824 Timberline Drive Austin, TX 78746 WO: 512/447-7707 x324 FAX: 512/447-3940 Email [email protected] CHANDRA CRAWFORD UNITY of Greater New Orleans 2475 Canal St. Suite 300 New Orleans, LA 70119 WO: 504/821-4496 FAX: 504/821-4704 [email protected] MICHAEL DAHL Public Policy Director HOME Line 3455 Bloomington Ave Minneapolis, MN 55407 WO: 612-728-5770 x111 [email protected] JOE FINN Mass. Housing and Shelter Alliance PO Box 120079 Boston, MA 02112 WO: 617/737-6447 FAX: 617-367-5709 [email protected] HUGH GROGAN Minnehaha County Department of Human Service 521 N. Main Ave. Ste 201 Sioux Falls, SD 57104 WO: 605-367-4217, ext 113 Email [email protected] JEREMY HAILE Lawyer 2500 Q Street NW, Apt. 508 Washington, DC 20007 Email: [email protected]
LAURA HANSEN C.E.O. Coalition to End Homelessness P.O. Box 030177 Fort Lauderdale, FL 33303 WO: 954-792-4000 Fax: 954-585-1964 Email: [email protected] TINA HAYWARD Partners to End Homelessness PO Box 820138 Vicksburg, MS 39182 WO: 601/661-8990 FAX: 601/661-6233 [email protected] REY LOPEZ President The King’s Outreach PO Box 1591 Cabot, AR 72023 WO: 501/843-9564 FAX: 501/605-0352 Email: [email protected] PATRICK MARKEE Coalition for the Homeless, Inc. 129 Fulton St. New York, NY 10038 Ph. 212-776-2004 Fax: 212-964-1303 Email: [email protected] PHOEBE NELSON Executive Director Women’s Resource Center of North Central Washington P.O. Box 2051 Wenatchee, WA 98807 WO: 509/662-0121 FAX: 509/662-9435 Email: [email protected]
Bringing America Home
GLORIN RUIZ PASTUSH La Fondita de Jesus Caleta San Juan 55A San Juan, PR 00901 Email [email protected] GREG SILEO Baltimore Homeless Services 210 Guilford Ave; 2nd floor Baltimore, MD 21202 WO: 410/545-3016 Cell (work): 410/361-0641 FAX: 410/396-1590 Email: [email protected] YVONNE VISSING Salem State College 726 Raymond Rd. Chester, NH 03036 WO: 603/498-5985 [email protected] DONALD WHITEHEAD St. Vincent de Paul of Baltimore 402 S. Bond St. Baltimore, MD 21231 WO: 410/732-1892 FAX: 410/558-1675 [email protected]
Bringing America Home
National Coalition for the Homeless 2201 P Street, NW Tel. 202-462-4822 Washington, DC 20037-1033 Fax. 202-462-4823 http://www.nationalhomeless.org Email. [email protected] INDIVIDUAL(S) RESPONSIBLE FOR CUSTODY OF FUNDS: John Parvensky, Board President Colorado Coalition for the Homeless 2111 Champa St. Denver, CO 80205 INDIVIDUAL(S) RESPONSIBLE FOR DISTRIBUTION OF FUNDS: Neil Donovan, Executive Director 2201 P Street, NW Washington, DC 20037 INDIVIDUAL(S) RESPONSIBLE FOR FUND RAISING: Megan Hustings, Development Director 2201 P Street, NW Washington, DC 20037 INDIVIDUAL(S) RESPONSIBLE FOR CUSTODY OF FINANCIAL RECORDS: Sue Watlov Phillips, Board Treasurer Elim Transitional Housing, Inc. 3989 Central Ave. NE, Ste. 565 Minneapolis, MN 55421-3972 INDIVIDUAL(S) AUTHORIZED TO SIGN CHECKS: John Parvensky, Board President Sue Watlov Phillips, Board Treasurer Neil Donovan, Executive Director Megan Hustings, Development Director BANK(S) IN WHICH REGISTRANT’S FUNDS ARE DEPOSITED: SunTrust, Dupont Circle Branch 1369 Connecticut Ave, NW Washington, DC 20036 202-296-5527
Bringing America Home
National Coalition for the Homeless 2201 P Street, NW Tel. 202-462-4822 Washington, DC 20037-1033 Fax. 202-462-4823 http://www.nationalhomeless.org Email. [email protected]
ORGANIZATION ADDRESS RELATIONSHIP TYPE OF ORGANIZATION Aberdeen Foundation Nashville, TN Funder Foundation Agua Fund Inc Washington, DC Funder Foundation Burt and Diana Cutler Family Foundation Rolling Hills, CA Funder Foundation Colorado Coalition for the Homeless Denver, CO Member Local Advocacy Organization
and Service Provider Columbus foundation Columbus, OH Funder Foundation Combined Federal Campaign - Atlanta, GA Atlanta, GA Funder Combined Federal Campaign Combined Federal Campaign - Baltimore, MD
Baltimore, MD Funder Combined Federal Campaign
Combined Federal Campaign - L.A. Area Los Angeles, CA Funder Combined Federal Campaign Combined Federal Campaign - NE PA Area Scranton, PA Funder Combined Federal Campaign Combined Federal Campaign - North County (NY)
Watertown, NY Funder Combined Federal Campaign
Combined Federal Campaign - Philadelphia Area
Philadelphia, PA Funder Combined Federal Campaign
Combined Federal Campaign- Delaware Wilmington, DE Funder Combined Federal Campaign Combined Federal Campaign- Fort Polk Ft. Polk, LA Funder Combined Federal Campaign Combined Federal Campaign- LA Area Los Angeles, CA Funder Combined Federal Campaign Combined Federal Campaign- Lake County Illinois
Gurnee, IL Funder Combined Federal Campaign
Combined Federal Campaign- Monterey & Santa Cruz Counties
Monterey, CA Funder Combined Federal Campaign
Combined Federal Campaign- National Capital Area
Alexandria, VA Funder Combined Federal Campaign
Combined Federal Campaign- Niagara Frontier
Buffalo, NY Funder Combined Federal Campaign
Combined Federal Campaign Overseas Alexandria, VA Funder Combined Federal Campaign Combined Federal Campaign- Philadelphia Area
Philadelphia, PA Funder Combined Federal Campaign
Combined Federal Campaign- United Way California Capital Region
Sacramento, CA Funder Combined Federal Campaign
Combined Federal Campaign- United Way of Allegheny County
Pittsburgh, PA Funder Combined Federal Campaign
Combined Federal Campaign- United Way of Brevard County, Inc.
Cocoa, FL Funder Combined Federal Campaign
Combined Federal Campaign- United Way of Central Carolinas, Inc
Charlotte, NC Funder Combined Federal Campaign
Combined Federal Campaign- United Way of Southeastern Pennsylvania
Philadelphia, PA Funder Combined Federal Campaign
COSAC Foundation Davie, FL Funder Foundation Edna Wardlaw Charitable Trust Atlanta, GA Funder Foundation Elim Transitional Housing Columbia Hgts., MN Member Local Housing Provider Massachusetts Housing and Shelter Alliance
Boston, MA Member Local Advocacy Organization and Service Provider
Bringing America Home
ORGANIZATION ADDRESS RELATIONSHIP TYPE OF ORGANIZATION Miami Coalition for the Homeless Miami, FL Member Local Advocacy Organization
and Service Provider Presbyterian Church USA Louisville, KY Funder Foundation Proteus Fund Amherst, MA Funder Foundation Stern Sidney Memorial Trust Pacific Palisades, CA Funder Foundation United Synagogue Youth New York, NY Funder Foundation United Veterans of America Leeds, MA Member Advocacy Organization United Way of Larimer County Fort Collins, CO Funder Employee Giving Campaign United Way of New York City New York, NY Funder Employee Giving Campaign United Way of the California Capital Region
Sacramento, CA Funder Employee Giving Campaign
Winky Foundation Oroville, WA Funder Foundation World Bank Community Connections Fund Washington, DC Funder Employee Giving Campaign
